Psychiatric Mental Health Nursing by Videbeck

➤ KEY POINTS

• Neurobiologic research is constantly expand-
  ing our knowledge in the field of psychiatry
  and is significantly affecting clinical practice.


• The cerebrum is the center for coordination
  and integration of all information needed to
  interpret and respond to the environment.


• The cerebellum is the center for coordination
  of movements and postural adjustments.


• The brain stem contains centers that control
  cardiovascular and respiratory functions,
  sleep, consciousness, and impulses.


• The limbic system regulates body tempera-
  ture, appetite, sensations, memory, and
  emotional arousal.


• Neurotransmitters are the chemical sub-
  stances manufactured in the neuron that aid
  in the transmission of information from the
  brain throughout the body. Several impor-
  tant neurotransmitters including dopamine,
  norepinephrine, serotonin, histamine, acetyl-
  choline, GABA, and glutamate, have been
  found to play a role in mental disorders and
  are targets of pharmacologic treatment.


• Researchers continue to examine the role of
  genetics, heredity, and viruses in the devel-
  opment of mental illness.
  
  
  • Pharmacologic treatment is based on the
    ability of medications to eliminate or mini-
    mize identified target symptoms.
  
  
  • The following factors must be considered in
    the selection of medications to treat mental
    disorders: the efficacy, potency, and half-life
    of the drug; the age and race of the client;
    other medications the client is taking; and
    the side effects of the drugs.
  
  
  • Antipsychotic drugs are the primary treat-
    ment for psychotic disorders such as schizo-
    phrenia, but they produce a host of side ef-
    fects that also may require pharmacologic
    intervention. Neurologic side effects, which
    can be treated with anticholinergic medica-
    tions, are called extrapyramidal symptoms
    and include acute dystonia, akathisia, and
    pseudoparkinsonism. Some of the more
    serious neurologic side effects include
    tardive dyskinesia (permanent involuntary
    movements) and neuroleptic malignant
    syndrome, which can be fatal.
  
  
  • Because of the serious side effects of anti-
    psychotic medications, clients must be well
    educated regarding their medications, med-
    ication compliance, and side effects. Health
    care professionals must closely supervise
    the regimen.
  
  
  • Antidepressant medications include cyclic
    compounds, SSRIs, MAOIs, and a group of
    newer drugs.
  
  
  • The nurse must carefully instruct clients
    receiving MAOIs to avoid foods containing
    tyramine, because the combination produces
    a hypertensive crisis that can become life-
    threatening.
  
  
  • The risk of suicide may increase as clients
    begin taking antidepressants. While suicidal
    thoughts are still present, the medication
    may increase the client’s energy, which may
    allow the client to carry out a suicide plan.
  
  
  • Lithium and selected anticonvulsants are
    used to stabilize mood particularly in bipolar
    affective disorder.
  
  
  • The nurse must monitor serum lithium levels
    regularly to ensure the level is in the thera-
    peutic range and to avoid lithium toxicity.
    Symptoms of toxicity include severe diarrhea
    and vomiting, drowsiness, muscle weakness,
    and loss of coordination. Untreated, lithium
    toxicity leads to coma and death.
  
  
  • Benzodiazepines are used to treat a wide
    variety of problems related to anxiety and
    insomnia. Clients taking them should avoid
    alcohol, which increases the effects of the
    benzodiazepines.
  
  
  
  

2 NEUROBIOLOGICTHEORIES ANDPSYCHOPHARMACOLOGY 43

Critical Thinking Questions

1.It is possible to identify a gene associated with

increased risk for the late onset of Alzheimer’s

disease. Should this test be available to any-

one who requests it? Why or why not? What

dilemmas might arise from having such

knowledge?

2.What are the implications for nursing if it be-

comes possible to predict certain illnesses,

such as schizophrenia, through the identifica-

tion of genes responsible for or linked to the

disease? Should this influence whether people

who carry such genes should have children?

Who should make that decision, given that

many people with chronic mental illness de-

pend on government programs for financial

support?

3.Drug companies research and develop new

durgs. Much more money and effort is ex-

pended to produce new drugs for common dis-

orders rather than drugs needed to treat rare

disorders, such as Tourette syndrome (often

called “orphan drugs”). What are the ethical

and fiancial dilemmas associated with re-

search designed to produce new drugs?